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Grantee
SEWA is a trade union of 1.1 million poor, self-employed women workers. Established in 1972, its main goals are to organize women for full employment and self-reliance. VimoSEWA is SEWA's insurance unit in which the workers themselves are the users and managers of all services. It was developed in 1992 in response to members' needs for protection. VimoSEWA promotes an integrated insurance product of life, health, accident and asset coverage for poor workers and their families.
Project Summary
- Project name: Bringing "Health" into Health Insurance: Evidence for a Converged Approach
- Project start date: January 2009
- Duration: 3 years
- Country: India
Beneficiaries
This research initiative will target workers in the informal economy in urban and rural Gujarat, India. SEWA members are home-based workers, producers, vendors, and manual laborers including agricultural laborers. They do not have basic statutory social protection such as health care benefits, maternity or sick leave, pension and access to child care.
Project Description
Building on SEWA's existing community health program, VimoSEWA will conduct action research among insured households in urban and rural locations. The objective is to measure the impact of integrating community health activities with health insurance on reducing insurance claim rates and illness expenditure of households. Health insurance has proven to be a primary need of the poor: over 90% of VimoSEWA's claims are for illness expenditure, one-third of which are for highly preventable illnesses such as malaria, gastroenteritis and other water-borne diseases. SEWA's experience indicates that these diseases, if treated early in a primary health setting, often do not require hospitalization. Untreated, these illnesses may eventually require costly hospitalization, and cause unnecessary loss of income and assets by the poor. Such negative outcomes also impede the viability of health insurance.
Key Challenges
- Health insurance itself may be an incentive for hospitalization, as care can be purchased at a lower cost. Thus,
despite health education and referrals, there is a possibility that hospitalization rates will not decrease significantly.
- There may be a spillover effect of health interventions, whereby the control group is influenced by the intervention
being deployed within the study group.
- To develop easy to understand, effective health communication messages that can prevent illness or hospitalization.
Learning Agenda
As very little evidence exists in this area, VimoSEWA aims to create both an implementation model and evidence base for integration of health activities with health insurance. This project will address five key questions through action research using a controlled study of the impact of health interventions amongst insured households.
- How does a community health program impact health seeking behavior?
- Does a community health program reduce health insurance claims and/or out of pocket illness expenditure
for preventable, primary illnesses?
- What health education messages are effective in reducing unnecessary hospitalization?
- What is the pattern of treatment sought for the most common illnesses?
- Does a community health program contribute to the viability of health insurance?
Quotes
"I am an agarbatti worker. I earn 30 rupees per day rolling incense sticks which we call agarbattis.
I live in a small ten-by-fifteen room with my family. Earlier we did not have running water. I got sick with
typhoid and malaria and spent a big part of my savings on my illness. Luckily, I was insured by SEWA and was
reimbursed within a week. Our lives are like this - up and down. We need social security like insurance."
Jaitoonbibi, Agarbatti worker, Ahmedabad city, Gujarat
"All that we women know is work and more work. Whatever we have been through we cannot change.
But we dream of a better life for our children. That's why VimoSEWA is so important for us."
Chanchiben, agricultural laborer, Kheda district, Gujarat
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More information on the project
Websites of the grantee:
References:
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Ranson, MK, Sinha T, Chatterjee M, Acharya A, Bhavsar A, Morris SS, Mills A: "Making health insurance work for the poor:
learning from SEWA's community-based health insurance scheme" in Social Science and Medicine 62 (2006), pp707-720 -
(pdf 248 KB)
- Chatterjee, M., "Microinsurance for workers in the informal economy", SEWA, 2006
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Sinha, T, et al., "Barriers to accessing benefits in a community-based insurance scheme: lessons learnt from SEWA
Insurance, Gujarat, Oxford University Press, 2005 - (pdf 153 KB)
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